Provider Demographics
NPI:1245572973
Name:PENNINGTON, TAMI C (LPC)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:C
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RESOURCE LANE
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680
Mailing Address - Country:US
Mailing Address - Phone:770-733-2705
Mailing Address - Fax:
Practice Address - Street 1:200 RESOURCE LN
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8361
Practice Address - Country:US
Practice Address - Phone:770-733-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007223101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health